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 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Emphysematous gastritis (EG) is a rare cause of abdominal pain, which should be differentiated from gastric emphysema. It is hypothesized to result from air-producing microorganisms in patients with underlying predisposing factors. Because of the non-specific presentation of EG, it is diagnosed radiographically. CT scan is the diagnostic modality of choice that typically reveals irregular, mottled appearance of the air in the thickened gastric wall and in the portal vein in the liver. We report a rare case of EG in a male with a history of diabetes mellitus who presented to the emergency department with diarrhea, nausea, vomiting, and epigastric pain. On examination, he was hypotensive and had mild tenderness in the epigastrium. Laboratory tests revealed leukocytosis, elevated lactate, anion gap metabolic acidosis, and acute kidney injury. A non-contrast CT abdomen revealed findings consistent with EG. Even though mortality rate in access of 60% have been reported without prompt surgical intervention in EG, recent literature suggests favorable prognosis with conservative measures in patients without an overt surgical indication. Our patient was also managed conservatively with IV antibiotics and gradual advancement of diet and had complete resolution of symptoms over the ensuing few days. The factors that correlate with a poor prognosis include elevated serum lactate, serum creatinine, and concomitant pneumatosis in small bowel and colon.
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PMID:A case report of emphysematous gastritis in a diabetic patient: favorable outcome with conservative measures. 2633 58

Emphysematous gastritis is a severe and rare form of gastritis with characteristic findings of intramural gas in the stomach. It is an acute life-threatening condition resulting from gas-producing microorganisms invading the stomach wall. Early diagnosis and initiation of treatment with bowel rest, hydration, and intravenous broad-spectrum antibiotics is imperative for an effective outcome. Surgical intervention is reserved for perforations, peritonitis, strictures, and uncontrolled disseminated sepsis. We present a case of an 82-year-old female with prior history of colon and uterine cancer on remission treated with surgeries who presented with bilious vomiting, abdominal discomfort, and nausea. She was tachycardic and had a diffusely tender abdomen with rebound on examination. Her laboratory results including blood count, serum chemistry, and coagulation studies were normal. She was diagnosed with emphysematous gastritis based on the characteristic radiographic findings of intramural stomach gas and also the presence of gas in the portal venous system. It is important to differentiate emphysematous gastritis from gastric emphysema because of the difference in management and prognosis, as emphysematous gastritis has a worse outcome and requires aggressive management. Despite an anticipated poor prognosis due to the known grave outcomes of emphysematous gastritis, our patient was successfully managed with conservative treatment. We concluded that she developed emphysematous gastritis probably secondary to immunosuppression and possible mucosal tears from multiple bouts of vomiting. She had a stable hospital course and resolution with medical management most likely due to early diagnosis and initiation of appropriate treatment.
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PMID:A combination of intramural stomach and portal venous air: conservative treatment. 2690 89

Emphysematous gastritis is a rare infection of the gastric wall with 55%-60% mortality. A 44-year-old man with AIDS, hepatitis C, and intravenous drug use presented with a 1-day history of acute-onset abdominal pain, nausea, and nonbloody, nonbilious emesis. On examination, he was afebrile without other vital sign abnormalities. He had epigastric abdominal tenderness without rebound or guarding. The peripheral-blood leukocyte count was elevated to 12.8 with 93.8% neutrophils. The patient's clinical presentation markedly improved with IV fluids and broad-spectrum antibiotic therapy. His presentation and radiologic findings, including gastric intramural air and air in the portal vein, are consistent with emphysematous gastritis. Conservative management is first-line for milder cases of emphysematous gastritis. Exploratory laparotomy and total gastrectomy are indicated only in severe cases such as transmural ischemia and peritonitis. Immune-compromised status is a predisposing factor and associated with subtler findings than the classic dramatic clinical presentation.
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PMID:Air in the gastric wall of a patient with AIDS. 2882 9

Median arcuate ligament compression syndrome is an anatomical and clinical entity defined by a combination of extrinsic compression of the coeliac axis by the median arcuate ligament and clinical manifestations. The majority of patients with features of compression experience no symptoms. The most common clinical symptoms when present are epigastric pain, nausea, vomiting and weight loss. Hypertrophy of the median arcuate ligament is a rare cause of chronic abdominal pain. We present a case of an elderly male patient who presented with acute epigastric pain, and gastric and intrahepatic portal pneumatosis on CT imaging. Emphysematous gastritis, caustic ingestion and other causes of this imaging presentation were ruled out. Imaging also showed chronic compression of the coeliac axis with compensatory hypertrophy of the gastroduodenal artery. Gastric ischaemia is a rare presentation of this syndrome, which occurs owing to the failure of compensatory mechanisms and resultant ischaemic injury to a virtual watershed vascular territory of the gastric wall. Conservative management was performed, including volume restoration, intravenous proton pump inhibitor therapy, broad-spectrum antibiotic therapy and blood transfusion. No surgical or endovascular interventional procedures were carried out. The patient showed clinical improvement soon after the initiation of treatment. Disappearance of the imaging findings was documented 2 weeks after treatment. Complete endoscopic recovery and absence of clinical alterations were observed during follow-up after 3 months.
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PMID:Gastric ischaemia as an unusual presentation of median arcuate ligament compression syndrome. 3036 66